Arterial Blood Gas Sampling and analysis: Radial Approach

1. Arterial Blood Gas Sampling and analysis:Radial Approach Presented by: Jonna Bobeck BSN, RN, CEN

2. Objectives • Understand ABG • Discuss indications • Describe contraindications for performing an arterial puncture. • Demonstrate the technique for performing an arterial puncture. • Analyze and interpret results

3. Introduction • ABG sampling • Information with limitations

4. Indications • Determination of pH and partial pressure of respiratory gases • Determination of other serum blood levels • Assessment of patient response to therapeutic interventions • Assessment of progression of disease process

5. Contraindications • Coagulopathy, anticoagulant meds, thrombolysis • Abnormalities of the overlying skin • Prior vascular surgery at or proximal to the entry site • Inadequate circulation

6. The Allen Test • Assess collateral circulation

7. Equipment • Gloves • Antiseptic solution • Syringe • 1% lidocaine (optional) • 1.5-inch 22 to 23 guage needle • Specimen bag with ice • Syringe cap • Bandage

8. Anatomy of Radial Artery • Preferred site • Superficial location • Relatively immobile

9. Procedure • Explain procedure • Universal precautions • Prepare region • Local anesthetic: optional

10. Procedure: Initial Artery Approach • Allen test • Position • Identify artery

11. Specimen Collection • Slowly advance • Blood will fill syringe spontaneously • If unsuccessful withdraw and redirect • Prepare specimen for submission to lab

12. Post Procedure Care • Apply direct pressure

13. Complications • Hematoma • Distal ischemia • Pseudoaneurysm • Localized trauma • Infection

14. review

15. Where are abg kits kept in the ed? Trauma 2 Dirty Utility Supply Pyxis Materials

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17. Congratulations That is correct

18. A modified Allen's test is only required for patient’s with poor circulation? True False

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20. Congratulations That is correct

21. If unsuccessful withdraw to epidermis and redirect? True False

22. Sorry Try again

23. Congratulations That is correct

24. Place the abg on ice and tube to lab? True False

25. Sorry please walk to lab and no ice if delivered in less than 15 minutes

26. Congratulations That is correct

27. Happy nurses and patient make for an awesome shift? Absolutely Not Really

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29. Congratulations That is correct

30. Analysis • Part of diagnosis

31. Overview • pH (7.35 – 7.45) • PaCO2 (35 – 45) • PaO2 (80 – 100) • HCO3 (23 – 27) • Respiratory buffer response • Renal buffer response

32. Acid base disorders Respiratory acidosis Respiratory alkalosis

33. Acid base disorders Metabolic acidosis Metabolic alkalosis

34. Components of ABG • pH • PaO2 • PaCO2 • HCO3 • Base Excess (B.E.)

35. Steps to Interpretation: ABG town • Look at pH to determine the first and last name of your ABG • Look at CO2 and HCO3 to determine which one has same last name

36. FIRST MIDDLE LAST Compensated Respiratory Acidosis Uncompensated Metabolic Alkalosis pH Uncompensated Acid…………..7.35 --- 7.45……………Uncompensated Alk CO2 Respiratory Acid Respiratory Alkalosis………………35 – 45………………Respiratory Acidosis HCO3 Metabolic Base Metabolic Acidosis………………….23 – 27………………Metabolic Alkalosis Compensated Gases 7.35…………………………….......7.40/7.41………………………………..7.45 Compensated Acidosis Compensated Alkalosis

37. Example One Jane Doe is a 45 year-old female admitted to the nursing unit with a severe asthma attack. She has been increasing shortness Of breath since admission three hours ago. Her arterial blood gas result is as follows: pH – 7.22 CO2 – 55 HCO3 – 25 B.E - 23

38. Result • First name – uncompensated • Last name – acidosis • Look at CO2 and HCO3 to determine which one has the same last name • CO2 – 55 (acidosis) • Uncompensated respiratory acidosis

39. Example Two John Doe is a 55 year-old male admitted to your Emergency Department with a bowel Obstruction. He has been experiencing intractable vomiting for the last several hours. His arterial blood gas result is as follows: pH – 7.50 CO2 – 42 HCO3 – 33 B.E. - 26

40. Result • First name – uncompensated • Last name – alkalosis • Look at CO2 and HCO3 to determine which one has the same last name • HCO3 – 33 (alkalosis) • Uncompensated metabolic acidosis

41. Compensation • Over time the body attempts to compensate • Uncompensated, partially compensated, fully compensated • When the CO2 or HCO3 go in the opposite direction of the pH there is compensation by that system

42. A Bit harder pH = 7.36 PaCO2 = 56 HCO3- = 26 pH = 7.43 PaCO2 = 32 HCO3- = 29 pH = 7.35 PaCO2 = 31 HCO3- = 18.1 pH = 7.19 PaCO2 = 45 HCO3- = 18.1 pH = 7.44 PaCO2 = 47 HCO3- = 26

43. The prefix to the name pH = 7.09 PaCO2 = 50 HCO3- = 30 pH = 7.21 PaCO2 = 55 HCO3- = 28 pH = 7.67 PaCO2 = 60 HCO3- = 45 pH = 7.45 PaCO2 = 33 HCO3- = 20 pH = 7.01 PaCO2 = 20 HCO3- = 10

44. O2 and base excess pH 7.34, PCO2 34, HCO3- 18.6, BE -6, PO2 86% pH 7.58, PCO2 48, HCO3 48, BE +22, PO2 59%

45. Practice test

46. Mrs. Smith is a 65 year-old woman who is in your ED with decreased level of consciousness. Her ABG results: pH – 7.28 PCO2 – 74 HCO3 - 26 What is the acid base disturbance? Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

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48. Congratulations That is correct

49. Is Her ABG Compensated or Uncompensated? Compensated Uncompensated

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